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Fitzek MP, Mecklenburg J, Overeem LH, Lange KS, Siebert A, Triller P, Neeb L, Dreier JP, Kondziella D, Reuter U, Raffaelli B. Alice in Wonderland Syndrome (AIWS): prevalence and characteristics in adults with migraine. J Neurol 2024; 271:5146-5155. [PMID: 38822148 PMCID: PMC11319383 DOI: 10.1007/s00415-024-12471-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE Alice in Wonderland Syndrome (AIWS) is a sensory disorder characterized by a distorted somatosensory and/or visual perception. Additionally, distortion of time perception and symptoms of derealization/depersonalization may occur. AIWS is frequently associated with migraine. However, its prevalence, and clinical characteristics remain poorly understood. Here, we investigated the prevalence and features of AIWS in individuals with migraine. We hypothesized AIWS is more frequent in migraine patients with aura than in those without aura. METHODS This was a prospective cross-sectional cohort study, conducted at a tertiary headache center. Participants with migraine filled out questionnaires, providing details on demographics, headache, AIWS characteristics and the occurrence of transient visual phenomena such as fragmented vision. RESULTS Of 808 migraine patients, 133 individuals (16.5%, mean age 44.4 ± 13.3 years, 87% women) reported AIWS symptoms throughout their lives. Micro- and/or telopsia (72.9%) were most frequent, followed by micro- and/or macrosomatognosia (49.6%), and macro- and/or pelopsia (38.3%), lasting on average half an hour. AIWS symptoms occurred in association with headache in 65.1% of individuals, and 53.7% had their first AIWS episode at the age of 18 years or earlier. Migraine patients with aura were more likely to report AIWS symptoms than those without aura (19.5% vs. 14.1%, p = 0.04). Participants with AIWS reported a higher incidence of 17 out of the 22 investigated visual phenomena. CONCLUSION AIWS symptoms appear to be a common lifetime phenomenon in migraine patients. The correlation and clinical parallels between AIWS and migraine aura could indicate shared underlying pathomechanisms.
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Affiliation(s)
- Mira P Fitzek
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Junior Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany
| | - Jasper Mecklenburg
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Lucas H Overeem
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Kristin S Lange
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany
| | - Anke Siebert
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Paul Triller
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Lars Neeb
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Helios Global Health, Berlin, Germany
| | - Jens P Dreier
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Center for Stroke Research, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, GermanyUniversitätsmedizin Berlin, Berlin, Germany
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Berlin, Germany
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uwe Reuter
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Universitätsmedizin Greifswald, Greifswald, Germany
| | - Bianca Raffaelli
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany.
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2
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Frattale I, Papetti L, Ursitti F, Sforza G, Monte G, Voci A, Proietti Checchi M, Mazzone L, Valeriani M. Visual Disturbances Spectrum in Pediatric Migraine. J Clin Med 2023; 12:jcm12082780. [PMID: 37109116 PMCID: PMC10143789 DOI: 10.3390/jcm12082780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Migraine is a complex neurological disorder with partially unknown pathophysiological mechanisms. The prevalence in childhood ranges from 7.7% to 17.8%, thus representing the most frequent primary headache. In half of the cases, migraine is accompanied or preceded by various neurological disturbances, among which the visual aura is the best known. In literature, other conditions, such as Alice in Wonderland Syndrome and Visual Snow syndrome, are characterized by visual manifestations and are often associated with migraine. The aim of this narrative review is to describe the spectrum of visual disturbances in pediatric migraine and their pathophysiological mechanisms.
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Affiliation(s)
- Ilaria Frattale
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Hospital of Rome, Tor Vergata University, 00165 Rome, Italy
| | - Laura Papetti
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Fabiana Ursitti
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Giorgia Sforza
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Gabriele Monte
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Alessandra Voci
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | | | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Hospital of Rome, Tor Vergata University, 00165 Rome, Italy
| | - Massimiliano Valeriani
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
- Center for Sensory Motor Interaction, Aalborg University, 9220 Aalborg, Denmark
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3
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Saito G, Takagi G. Multisensory perceptual distortion including auditory distortions in Alice in Wonderland syndrome: a case report. Neurocase 2023; 29:46-49. [PMID: 38678303 DOI: 10.1080/13554794.2024.2345402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
Alice in Wonderland syndrome (AIWS) is a rare perceptual disorder characterized mainly by perceptual distortions of visual objects and one's own body. While there are many case reports of visual and somatosensory distortions associated with AIWS, little is known about auditory distortion. Therefore, we present the case of a 22-year-old right-handed woman who described having auditory as well as visual and somatosensory distortion experiences and a family history of AIWS. The subject reported experiencing multisensory perceptual distortions, where she sees other people's faces as larger and hears their voices as louder at the same time. This particular case suggests that auditory distortion - which contributes to constructing the perception of the surrounding space and the body - may also be characterized as a perceptual symptom of AIWS.
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Affiliation(s)
- Godai Saito
- Research Institute of Electrical Communication, Tohoku University, Sendai, Japan
- Department of Psychology, Graduate School of Arts and Letters, Tohoku University, Sendai, Japan
| | - Gen Takagi
- Faculty of Comprehensive Welfare, Tohoku Fukushi University, Sendai, Japan
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4
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Infectious causes of Alice in Wonderland syndrome. J Neurovirol 2021; 27:550-556. [PMID: 34101086 DOI: 10.1007/s13365-021-00988-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/21/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
Alice-in-Wonderland syndrome (AIWS) is a perceptual disorder embracing a spectrum of self-experienced paroxysmal body image illusions including most commonly distortions of shape (metamorphopsia), size (macropsia or micropsia), distance (pelopsia or teleopsia), movement, and color among other visual and somesthetic distortions. Depersonalization, derealization, and auditory hallucinations have also been described. Recent reports suggest that infectious diseases are the predominant etiology for AIWS, especially among children. This article reviews current understanding regarding the association between infection and development of AIWS.
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5
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Mastria G, Mancini V, Cesare MD, Puma M, Alessiani M, Petolicchio B, Viganò A, Di Piero V. Prevalence and characteristics of Alice in Wonderland Syndrome in adult migraineurs: Perspectives from a tertiary referral headache unit. Cephalalgia 2021; 41:515-524. [PMID: 33167711 DOI: 10.1177/0333102420968245] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Migraine affects how the brain processes sensory information at multiple levels. The aberrant integration of visual and somatosensory stimuli is thought to underlie Alice in Wonderland Syndrome, a disorder often reported as being associated with migraine. However, there is still a lack of knowledge about the epidemiology of this syndrome in migraineurs and the association between Alice in Wonderland Syndrome episodes and migraine attacks. Therefore, we conducted a prospective cohort study to systematically evaluate the prevalence and the clinical features of Alice in Wonderland Syndrome in a large sample of patients with migraine. METHODS All the patients attending for the first time a tertiary-level headache clinic were consecutively screened for Alice in Wonderland Syndrome symptoms by means of an ad hoc questionnaire and detailed clinical interview, over a period of 1.5 years. Patients experiencing Alice in Wonderland Syndrome symptoms were contacted for a follow-up after 8-12 months. RESULTS Two hundred and ten patients were recruited: 40 patients (19%) reported lifetime occurrence of Alice in Wonderland Syndrome, 90% of whom (38/40) had migraine with aura. Thirty-one patients experienced episodes of Alice in Wonderland Syndrome within 1 h from the start of migraine headache. Patients reported either visual or visual and somatosensory symptoms (i.e. somatosensory symptoms never presented alone). We collected the follow-up details of 30 patients with Alice in Wonderland Syndrome, 18 of whom had been prescribed a preventive treatment for migraine. After 8-12 months, 5 of the treated patients reported a decrease, while 13 reported no episodes of Alice in Wonderland Syndrome. CONCLUSION Alice in Wonderland Syndrome prevalence in migraineurs was found to be higher than expected. Alice in Wonderland Syndrome was mostly associated with migraine with aura and tended to occur close to the migraine attack, suggesting the existence of a common pathophysiological mechanism. Patients treated with migraine preventive treatments had a higher chance of decreasing or even resolving Alice in Wonderland Syndrome episodes.
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Affiliation(s)
- Giulio Mastria
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,My Space Lab, Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Valentina Mancini
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Marco Di Cesare
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy
| | - Marta Puma
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy
| | - Michele Alessiani
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy
| | - Barbara Petolicchio
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy
| | | | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza - University of Rome, Rome, Italy.,University Consortium for Adaptive Disorders and Head Pain - UCADH, Pavia, Italy
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Blom JD, Nanuashvili N, Waters F. Time Distortions: A Systematic Review of Cases Characteristic of Alice in Wonderland Syndrome. Front Psychiatry 2021; 12:668633. [PMID: 34025485 PMCID: PMC8138562 DOI: 10.3389/fpsyt.2021.668633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Of the perceptual distortions characteristic of Alice in Wonderland syndrome, substantial alterations in the immediate experience of time are probably the least known and the most fascinating. We reviewed original case reports to examine the phenomenology and associated pathology of these time distortions in this syndrome. A systematic search in PubMed, Ovid Medline, and the historical literature yielded 59 publications that described 168 people experiencing time distortions, including 84 detailed individual case reports. We distinguished five different types of time distortion. The most common category comprises slow-motion and quick-motion phenomena. In 39% of all cases, time distortions were unimodal in nature, while in 61% there was additional involvement of the visual (49%), kinaesthetic (18%), and auditory modalities (14%). In all, 40% of all time distortions described were bimodal in nature and 19% trimodal, with 1% involving four modalities. Underlying neurological mechanisms are varied and may be triggered by intoxications, infectious diseases, metabolic disorders, CNS lesions, paroxysmal neurological disorders, and psychiatric disorders. Bizarre sensations of time alteration-such as time going backwards or moving in circles-were mostly associated with psychosis. Pathophysiologically, mainly occipital areas appear to be involved, although the temporal network is widely disseminated, with separate component timing mechanisms not always functioning synchronously, thus occasionally creating temporal mismatches within and across sensory modalities (desynchronization). Based on our findings, we propose a classification of time distortions and formulate implications for research and clinical practice.
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Affiliation(s)
- Jan Dirk Blom
- Outpatient Clinic for Uncommon Psychiatric Syndromes, Parnassia Psychiatric Institute, The Hague, Netherlands.,Faculty of Social Sciences, Leiden University, Leiden, Netherlands.,Department of Psychiatry, University of Groningen, Groningen, Netherlands
| | - Nutsa Nanuashvili
- Amsterdam Brain and Cognition Center, University of Amsterdam, Amsterdam, Netherlands
| | - Flavie Waters
- Clinical Research Centre, Graylands Hospital, North Metro Health Service Mental Health, Perth, WA, Australia.,School of Psychological Sciences, University of Western Australia, Perth, WA, Australia
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7
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Hossain MM. Alice in Wonderland syndrome (AIWS): a research overview. AIMS Neurosci 2020; 7:389-400. [PMID: 33263077 PMCID: PMC7701374 DOI: 10.3934/neuroscience.2020024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Alice in Wonderland syndrome (AIWS) is a rare neuropsychiatric condition characterized by distorted visual perceptions, body schema, and experience of time. A global overview of research on AIWS can inform future developments and clinical practice in this field. This bibliometric study aimed to analyze the characteristics of the global research landscape on AIWS. METHODS Bibliometric data on AIWS related publications published until 2019 were retrieved from the Web of Science database. The data were analyzed using statistical and scientometric tools to evaluate the publication trends, key research domains, top contributing journals, institutions, and countries associated with AIWS-related research. RESULTS A total of 125 published items were analyzed with a mean of 3 authors and 8.15 citations per document. Most articles were published after 2008, in medical journals focused on neuropsychiatric sciences, and most institutions affiliated with AIWS research were based on high-income countries. Major research domains associated with AIWS included visual disturbances, body image, migraine, infections, risk factors, and other clinical correlates. Several overarching domains were identified; however, clinical research on diagnosis, treatment, and prognosis of AIWS is relatively limited. CONCLUSION The current research landscape informs a developing trend in AIWS research in selected regions and specialties. Future research should emphasize multidisciplinary and translational investigations on clinical and epidemiological areas through global collaborations that may advance the knowledge and practice on AIWS.
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Affiliation(s)
- Md Mahbub Hossain
- Nature Study Society of Bangladesh, Khulna 09000, Bangladesh
- EviSyn Health, Khulna 09000, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 77843, USA
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8
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Chan A, Lerner C. Strange Visual Disturbances in an 8-year old Boy. Pediatr Rev 2020; 41:549-550. [PMID: 33004668 DOI: 10.1542/pir.2018-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Alvin Chan
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, CA
| | - Carlos Lerner
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, CA
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9
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Soldan SS, Lieberman PM. Epstein-Barr Virus Infection in the Development of Neurological Disorders. ACTA ACUST UNITED AC 2020; 32:35-52. [PMID: 33897799 DOI: 10.1016/j.ddmod.2020.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Epstein-Barr Virus (EBV) is a ubiquitous human herpesvirus that contributes to the etiology of diverse human cancers and auto-immune diseases. EBV establishes a relatively benign, long-term latent infection in over 90 percent of the adult population. Yet, it also increases risk for certain cancers and auto-immune disorders depending on complex viral, host, and environmental factors that are only partly understood. EBV latent infection is found predominantly in memory B-cells, but the natural infection cycle and pathological aberrations enable EBV to infect numerous other cell types, including oral, nasopharyngeal, and gastric epithelia, B-, T-, and NK-lymphoid cells, myocytes, adipocytes, astrocytes, and neurons. EBV infected cells, free virus, and gene products can also be found in the CNS. In addition to the direct effects of EBV on infected cells and tissue, the effect of chronic EBV infection on the immune system is also thought to contribute to pathogenesis, especially auto-immune disease. Here, we review properties of EBV infection that may shed light on its potential pathogenic role in neurological disorders.
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10
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Gündüz Ş. Metaphorising knowledge management: “ALICE in Wonderland”. KNOWLEDGE MANAGEMENT RESEARCH & PRACTICE 2019. [DOI: 10.1080/14778238.2019.1589398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Şafak Gündüz
- Faculty of Business and Management Sciences, Maltepe Universitesi, Istanbul, Turkey
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11
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Entezami P, Paul A, Adamo MA, Boulos AS. Transient Episode of Alice in Wonderland Syndrome After Ventriculoatrial Shunt Revision. World Neurosurg 2019; 121:149-151. [DOI: 10.1016/j.wneu.2018.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
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12
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Beh SC, Masrour S, Smith SV, Friedman DI. Clinical characteristics of Alice in Wonderland syndrome in a cohort with vestibular migraine. Neurol Clin Pract 2018; 8:389-396. [PMID: 30564492 PMCID: PMC6276353 DOI: 10.1212/cpj.0000000000000518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Alice in Wonderland syndrome (AIWS) is a rare sensory perception disorder, most often caused by migraine in adults. We aimed to characterize the clinical characteristics of AIWS in a cohort of vestibular migraine (VM) patients. METHODS Retrospective chart review of patients diagnosed with VM seen between August 2014 and January 2018. RESULTS Seventeen patients were identified (10 women) with a median age at onset of 45 years (range 15-61 years), and median age at presentation of 49 years (range 17-63 years). Eighty-two percent reported 1 AIWS symptom, 12% reported 3 symptoms, and 6% described 2 symptoms. The most common symptom was visual distortions (47%), followed by extrapersonal misperceptions (41%) and somesthetic distortions (29%). Most AIWS occurred during VM episodes (77%). Eleven patients were seen in follow-up; 10 described complete or partial resolution of both AIWS and VM with migraine preventive therapy, while 1 experienced complete resolution of VM but continued to have AIWS. Neuro-otologic abnormalities improved in 2 patients. CONCLUSIONS This study characterizes the clinical features of AIWS in patients with VM. We observed several rare and highly unusual AIWS misperceptions (frosted-glass vision, underwater vision, dolly zoom effect, sensation of the brain coming out of the head, closed-eye visual hallucinations, and headlight glare-induced marco/microsomatognosia), and resolution or improvement in AIWS and VM with migraine preventive treatment.
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Affiliation(s)
- Shin C Beh
- Departments of Neurology (SCB, SM, DIF) and Ophthalmology (DIF), University of Texas Southwestern Medical Center at Dallas; and Department of Neurology (SVS), Houston Methodist Neurological Institute, TX
| | - Shamin Masrour
- Departments of Neurology (SCB, SM, DIF) and Ophthalmology (DIF), University of Texas Southwestern Medical Center at Dallas; and Department of Neurology (SVS), Houston Methodist Neurological Institute, TX
| | - Stacy V Smith
- Departments of Neurology (SCB, SM, DIF) and Ophthalmology (DIF), University of Texas Southwestern Medical Center at Dallas; and Department of Neurology (SVS), Houston Methodist Neurological Institute, TX
| | - Deborah I Friedman
- Departments of Neurology (SCB, SM, DIF) and Ophthalmology (DIF), University of Texas Southwestern Medical Center at Dallas; and Department of Neurology (SVS), Houston Methodist Neurological Institute, TX
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Paniz-Mondolfi AE, Giraldo J, Rodríguez-Morales AJ, Pacheco O, Lombó-Lucero GY, Plaza JD, Adami-Teppa FJ, Carrillo A, Hernandez-Pereira CE, Blohm GM. Alice in Wonderland syndrome: a novel neurological presentation of Zika virus infection. J Neurovirol 2018; 24:660-663. [PMID: 30105501 DOI: 10.1007/s13365-018-0645-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/04/2018] [Accepted: 04/26/2018] [Indexed: 01/21/2023]
Abstract
Zika virus (ZIKV) is a flavivirus endemic in Africa and Southern Asian countries, which has recently emerged in unprecedented epidemic proportions around the world. Although ZIKV infection is often asymptomatic or distinguished by non-specific influenza-like symptoms, an increase in its pathogenicity and biological behavior has been the hallmark of the current pandemic. Increasing evidence suggests that neurotropic strains of ZIKV have evolved from less pathogenic strains of the virus. Neurological manifestations of ZIKV infection include a spectrum of congenital and non-congenital clinical entities, however visual somatosensory perceptual disorders have not been recorded to date. Herein, we report a case of a 15-year-old female who presented with a constellation of perceptual symptoms (metamorphopsia, telopsia, and pelopsia) following acute ZIKV infection. Although such symptoms may have originated from direct viral injury, a post-ZIKV autoimmune reaction to previously unexposed neuronal surface antigens or through molecular mimicry cannot be excluded. The development of Alice in Wonderland syndrome in our patient highlights the ever-increasing expanding spectrum of neurological symptoms associated to ZIKV infection.
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Affiliation(s)
- Alberto E Paniz-Mondolfi
- Department of Infectious Diseases and Tropical Medicine, Clínica IDB Cabudare. Instituto de Investigaciones Biomédicas IDB, Barquisimeto, 3023, Lara, Venezuela. .,Laboratorio de Señalización Celular y Bioquímica de Parásitos, Instituto de Estudios Avanzados (IDEA), Caracas, Caracas, Venezuela. .,Directorate of Health, Instituto Venezolano de los Seguros Sociales (IVSS), Caracas, Venezuela.
| | - José Giraldo
- Department of Ophtalmology and Neuro-ophtalmology, Hospital Internacional Barquisimeto, Barquisimeto, Venezuela
| | - Alfonso J Rodríguez-Morales
- Colombian Collaborative Network on Zika (RECOLZIKA), Pereira, Colombia.,Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Colombia
| | - Oriana Pacheco
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Venezuelan Science Incubator, Cabudare, 3023, Lara, Venezuela.,Health Sciences Department, College of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, 3001, Lara, Venezuela
| | - Germán Y Lombó-Lucero
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Venezuelan Science Incubator, Cabudare, 3023, Lara, Venezuela.,Health Sciences Department, College of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, 3001, Lara, Venezuela
| | - Juan D Plaza
- Health Sciences Department, College of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, 3001, Lara, Venezuela.,Health Sciences Department, College of Medicine, Universidad Nacional Experimental "Francisco de Miranda", Punto Fijo, Falcón, Venezuela
| | - Fabio J Adami-Teppa
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Venezuelan Science Incubator, Cabudare, 3023, Lara, Venezuela.,Division of Neuroradiology, Department of Radiology, Clínica IDB Cabudare. Instituto de Investigaciones Biomédicas IDB, Barquisimeto, 3001, Venezuela
| | - Alejandra Carrillo
- Health Sciences Department, College of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, 3001, Lara, Venezuela.,Health Sciences Department, College of Medicine, Universidad Nacional Experimental "Francisco de Miranda", Punto Fijo, Falcón, Venezuela
| | - Carlos E Hernandez-Pereira
- Infectious Diseases Research Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Venezuelan Science Incubator, Cabudare, 3023, Lara, Venezuela.,Health Sciences Department, College of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, 3001, Lara, Venezuela
| | - Gabriela M Blohm
- Department of Biology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
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15
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Farooq O, Fine EJ. Alice in Wonderland Syndrome: A Historical and Medical Review. Pediatr Neurol 2017; 77:5-11. [PMID: 29074056 DOI: 10.1016/j.pediatrneurol.2017.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/11/2017] [Accepted: 08/16/2017] [Indexed: 11/19/2022]
Abstract
Alice in Wonderland syndrome is a disorienting neurological condition that affects human perception to the senses of vision, hearing, touch, sensation, and the phenomenon of time. Individuals affected with Alice in Wonderland syndrome can experience alterations in their perception of the size of objects or their own body parts, known as metamorphopsias. It is known to occur in conditions including migraine, epilepsy, and certain intoxicants and infectious diseases. The name refers to Lewis Carrol's well-known children's book Alice's Adventures in Wonderland, in which the title character experiences alterations of sensation in which she felt that her body had grown too tall or too small, or parts of her body were changing shape, size, or relationship to the rest of her body. The syndrome was described in 1952 by Caro Lippman, and given its name in 1955 by John Todd. The metamorphopsias characteristic of this condition are also sometimes referred to as Lilliputian hallucinations, a reference to the fictional island of Lilliput in the novel Gulliver's Travels, written by Jonathan Swift in 1726. As such, many literary and medical publications have roots in the description of this syndrome. The purpose of this review is to summarize the literary and historical significance of Alice in Wonderland syndrome, as well as to provide the reader with a medical overview of the condition.
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Affiliation(s)
- Osman Farooq
- Division of Pediatric Neurology, Women and Children's Hospital of Buffalo, Buffalo, New York; Department of Neurology, Jacobs School of Medicine, State University of New York at Buffalo, Buffalo, New York.
| | - Edward J Fine
- Department of Neurology, Jacobs School of Medicine, State University of New York at Buffalo, Buffalo, New York
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O'Toole P, Modestino EJ. Alice in Wonderland Syndrome: A real life version of Lewis Carroll's novel. Brain Dev 2017; 39:470-474. [PMID: 28189272 DOI: 10.1016/j.braindev.2017.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 11/26/2022]
Abstract
Alice in Wonderland Syndrome was originally coined by Dr. John Todd in 1955. The syndrome is named after the sensations experienced by the character Alice in Lewis Carroll's novel Alice's Adventures in Wonderland. Alice in Wonderland Syndrome consists of metamorphopsia (seeing something in a distorted fashion), bizarre distortions of their body image, and bizarre perceptual distortions of form, size, movement or color. Additionally, patients with Alice in Wonderland Syndrome can experience auditory hallucinations and changes in their perception of time. Currently, there is no known specific cause of Alice in Wonderland Syndrome. However, theories point to infections such as the Epstein-Barr virus, medications such as topiramate and associated migraines. Neuroimaging studies have revealed brain regions involved with the manifestation of symptoms. These include the temporo-parietal junction within the temporal lobe and the visual pathway, specifically the occipital lobe. There are no current treatments for Alice in Wonderland Syndrome. Further research is needed to find better treatments for Alice in Wonderland Syndrome and to elucidate the exact cause or causes of Alice in Wonderland Syndrome.
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Affiliation(s)
- Patrick O'Toole
- Department of Neurology, Boston University School of Medicine, Boston, United States.
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Alice in Wonderland Syndrome: A Clinical and Pathophysiological Review. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8243145. [PMID: 28116304 PMCID: PMC5223006 DOI: 10.1155/2016/8243145] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/20/2016] [Indexed: 01/09/2023]
Abstract
Alice in Wonderland Syndrome (AIWS) is a perceptual disorder, principally involving visual and somesthetic integration, firstly reported by Todd, on the literary suggestion of the strange experiences described by Lewis Carroll in Alice in Wonderland books. Symptoms may comprise among others aschematia and dysmetropsia. This syndrome has many different etiologies; however EBV infection is the most common cause in children, while migraine affects more commonly adults. Many data support a strict relationship between migraine and AIWS, which could be considered in many patients as an aura or a migraine equivalent, particularly in children. Nevertheless, AIWS seems to have anatomical correlates. According to neuroimaging, temporoparietal-occipital carrefour (TPO-C) is a key region for developing many of AIWS symptoms. The final part of this review aims to find the relationship between AIWS symptoms, presenting a pathophysiological model. In brief, AIWS symptoms depend on an alteration of TPO-C where visual-spatial and somatosensory information are integrated. Alterations in these brain regions may cause the cooccurrence of dysmetropsia and disorders of body schema. In our opinion, the association of other symptoms reported in literature could vary depending on different etiologies and the lack of clear diagnostic criteria.
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Omata T, Fujii K, Kuroki H, Shimojo N. Alice in Wonderland syndrome associated with mycoplasma infection. Pediatr Int 2016; 58:1057-1059. [PMID: 27577175 DOI: 10.1111/ped.13039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/22/2016] [Accepted: 04/20/2016] [Indexed: 11/29/2022]
Abstract
Alice in Wonderland syndrome (AIWS) is a rare condition in which patients report distorted size perception of objects and their own bodies. Although specific causes and pathology have not been elucidated, an association between AIWS and infection has been suggested. To our knowledge, mycoplasma-induced AIWS has not been examined. A girl aged 7 years 11 months presented with fever (temperature, 40°C) and cough. Although the fever disappeared after approximately 10 days, she complained that her mother's face suddenly appeared smaller to her. Subsequently, she complained that objects intermittently appeared smaller than normal. Particle agglutination test indicated elevated serum antibodies against Mycoplasma pneumoniae. The patient was therefore diagnosed the patient with AIWS secondary to mycoplasma infection. Although mycoplasma infection is known to cause various central nervous system symptoms, this is the first report involving AIWS, suggesting that mycoplasma could affect visual function in children.
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Affiliation(s)
- Taku Omata
- Division of Child Neurology, Chiba Children's Hospital, Chiba, Japan.
| | - Katsunori Fujii
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Haruo Kuroki
- Medical Corporation Sigyounokai, Sotobo Children's Clinic, Chiba, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
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Valença MM, de Oliveira DA, Martins HADL. Alice in Wonderland Syndrome, Burning Mouth Syndrome, Cold Stimulus Headache, and HaNDL: Narrative Review. Headache 2015; 55:1233-48. [DOI: 10.1111/head.12688] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Marcelo M. Valença
- Neurology and Neurosurgery Unit, Department of Neuropsychiatry; Federal University of Pernambuco; Brazil
- Neurology and Neurosurgery Unit; Hospital Esperança; Brazil
| | - Daniella A. de Oliveira
- Neurology and Neurosurgery Unit, Department of Neuropsychiatry; Federal University of Pernambuco; Brazil
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Liu AM, Liu JG, Liu GW, Liu GT. "Alice in wonderland" syndrome: presenting and follow-up characteristics. Pediatr Neurol 2014; 51:317-20. [PMID: 25160537 DOI: 10.1016/j.pediatrneurol.2014.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 03/31/2014] [Accepted: 04/05/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigated the distribution of symptoms and etiologies of patients with "Alice in Wonderland" syndrome (visual perception of change in one's body size) and "Alice in Wonderland"-like syndrome (extrapersonal illusions) at presentation and to determine their prognosis. DESIGN Retrospective chart review and telephone interview. METHODS Charts of children diagnosed with "Alice in Wonderland" syndrome by a pediatric neuro-ophthalmologist between July 1993 and July 2013 were reviewed. Patients seen before 2012, or their parents, were contacted for follow-up information. RESULTS A total of 48 patients (average age 8.1 years) diagnosed with "Alice in Wonderland" syndrome or "Alice in Wonderland"-like syndrome were identified. Common visual symptoms were micropsia (69%), teleopsia (50%), macropsia (25%), metamorphopsia (15%), and pelopsia (10%). Magnetic resonance imaging and electroencephalography were unrevealing in 21 of 21 and 23 of 23 cases, respectively. The etiology was infection in 33% of patients and migraine and head trauma in 6% each. No associated conditions were found in 52%. Of the 15 patients with follow-up, 20% had a few more events of "Alice in Wonderland" syndrome or "Alice in Wonderland"-like syndrome, which eventually stopped after the initial diagnosis; 40% had no more events, and 40% were still having "Alice in Wonderland" syndrome or "Alice in Wonderland"-like syndrome symptoms at the time of the interview, while four patients (27%) developed migraines and one patient (7%) seizures since the diagnosis. CONCLUSION "Alice in Wonderland" syndrome and "Alice in Wonderland"-like syndrome typically affect young children, and the most common visual complaints are micropsia and teleopsia. The most common associated condition is infection, but half of these individuals have no obvious trigger. Magnetic resonance imaging and electroencephalography are not helpful. The symptoms of "Alice in Wonderland" syndrome and "Alice in Wonderland"-like syndrome usually resolve, but in more than one third of the cases, they continue. One quarter of patients without a history of migraine may subsequently develop migraine.
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Affiliation(s)
- Alessandra M Liu
- Neuro-ophthalmology Service, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan G Liu
- Neuro-ophthalmology Service, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Geraldine W Liu
- Neuro-ophthalmology Service, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Grant T Liu
- Neuro-ophthalmology Service, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Affiliation(s)
- Alex C Tselis
- Department of Neurology, School of Medicine, Wayne State University, Detroit, MI, USA.
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Bernal Vañó E, López Andrés N. Un caso de síndrome de Alicia en el país de las maravillas en probable relación con el uso de montelukast. An Pediatr (Barc) 2013; 78:127-8. [DOI: 10.1016/j.anpedi.2012.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 05/07/2012] [Accepted: 06/16/2012] [Indexed: 11/16/2022] Open
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Abstract
The Alice in Wonderland syndrome is a term applied to altered bizarre perceptions of size and shapes of a patient's body and illusions of changes in the forms, dimensions, and motions of objects that a patient with this syndrome encounters. These metamorphopsias arise during complex partial seizures, migraine headaches, infections, and intoxications. The illusions and hallucinations resemble the strange phenomena that Alice experienced in Lewis Carroll's Alice's Adventures in Wonderland. Charles Lutwidge Dodgson, whose nom de plume was Lewis Carroll, experienced metamorphopsias. He described them in the story that he wrote for Alice Liddell and her two sisters after he spun a tale about a long and strange dream that the fictional Alice had on a warm summer day. The author of this chapter suggests that Dodgson suffered from migraine headaches and used these experiences to weave an amusing tale for Alice Liddell. The chapter also discusses the neurology of mercury poisoning affecting the behavior of Mad Hatter character. The author suggests that the ever-somnolent Dormouse suffered from excessive daytime sleepiness due to obstructive sleep apnea.
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Affiliation(s)
- Edward J Fine
- University Neurology Service and The Jacobs Neurological Institute, Department of Neurology, University at Buffalo, The State University of New York, Buffalo General Medical Center, Buffalo, NY, USA.
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Bayen E, Cleret de Langavant L, Fénelon G. [The Alice in Wonderland syndrome: an unusual aura in migraine]. Rev Neurol (Paris) 2012; 168:457-9. [PMID: 22406233 DOI: 10.1016/j.neurol.2011.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 11/21/2011] [Accepted: 12/06/2011] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The Alice in Wonderland syndrome consists in a perceptual distortion of one's body size and shape. It is rarely encountered in adults, where it is mainly associated with migraine with aura and epilepsy. CASE REPORT A 37-year-old woman had had a migraine without aura since puberty. In the months following a parturition, she experienced several epidodes of unusual auras preceding typical migrainous headache. The aura lasted about 30min and consisted in the feeling of lengthening of the trunk and of the four limbs, associated with a sensation of well-being. DISCUSSION AND CONCLUSION Epileptologic and experimental data suggest that the Alice in Wonderland syndrome is associated with a transient dysfunction of associative somatosensory areas in the parietal cortex.
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Affiliation(s)
- E Bayen
- Service de médecine physique et réadaptation, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'hôpital, Paris, France.
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